A Prospective, Multi-Institutional Study of Adjuvant Radiotherapy After Resection of Malignant Phyllodes Tumors

Barth, Richard J.; Wells, Wendy A.; Mitchell, Sandra E.; Cole, Bernard F.

doi:10.1245/s10434-009-0489-2

Cited by 197 publications

(180 citation statements)

References 38 publications

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“…6 The current recommended treatment for fibroepithelial neoplasms is surgical excision with negative margins, although some investigators advocate a more aggressive management such as radiation therapy in phyllodes tumors. 8 Surgical recommendations are based on a clear and reproducible inverse association between widely clear margin status and recurrence rate for malignant phyllodes tumors. [9][10][11][12][13] The definition of negative margin varies widely across authors, with some advocating a clear margin of 41 cm.…”

Section: Discussionmentioning

confidence: 99%

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

2016

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Breast phyllodes tumors are uncommon fibroepithelial neoplasms with a range of histologic features. Surgical excision is the primary management, but the need for excision to negative margins in benign and borderline phyllodes tumors is unclear. Here, we review the surgical management patterns and outcomes of 90 patients with benign and low-grade fibroepithelial lesions of the breast treated at our institution, including 19 borderline phyllodes tumors, 52 benign phyllodes tumors, and 19 representative neoplasms with overlapping features of fibroadenoma and benign phyllodes tumors, which were classified as 'fibroadenomas with phyllodal features'. In total, 52 (58%) had positive surgical margins on first excision, and of these 17 (33%) underwent re-excision to achieve negative margins. Residual tumor was identified in three (18%) re-excisions. Patients with fibroadenoma with phyllodal features were more likely to have a positive surgical margin than with benign phyllodes tumors or borderline phyllodes tumors (89 vs 49%, P = 0.0015), and were less likely to undergo re-excision for positive margins (12 vs 43%, P = 0.031). In total, there were three recurrences (3%), with one per fibroadenoma with phyllodal features, benign phyllodes tumor, and borderline phyllodes tumor. There was no statistically significant difference in recurrence rates between patients with positive or negative margins, or between patients with positive margin with or without re-excision. The extent of the positive margin did not predict recurrence. In conclusion, the recurrence rate of benign and low-grade fibroepithelial lesions is low and not associated with the original margin status. Patients with fibroadenomas with phyllodal features, benign phyllodes tumors, or selected borderline phyllodes tumors and positive margins on initial excision may be managed conservatively, with close follow-up and timely re-excision of any potential recurrence.

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Section: Discussionmentioning

confidence: 99%

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

2016

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“…33 A study has concluded that the local recurrence with adjuvant radiotherapy was significantly lesser than patients treated with margin-negative resection alone. 35 Hence, by giving adjuvant radiotherapy in marginnegative resection can provide an effective way for local control of borderline and malignant phyllodes tumors.…”

Section: Managementmentioning

confidence: 99%

Approaches to phyllodes tumour of the breast: a review article

et al. 2017

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Phyllodes tumours are rare entities of fibroepithelial diseases. The exact pathogenesis and their relationship with fibroadenomas are oblivious. Women aged between 35 to 55 years are commonly affected, even younger in Asian population. Triple assessment should be applied as a guide to management in any breast pathology. Clinical appearances are typically diagnostic for phyllodes tumours. Even though sometimes inconclusive, mammography and ultrasonography are the main imaging modalities. Although the role of cytology is debatable, presence of both epithelial and stromal elements supports the diagnosis especially in malignant type. Core biopsy is rather favored in view of higher accuracy for the diagnosis. Accurate preoperative assessment and histologic diagnosis allow correct surgical intervention and subsequent avoidance of reoperation. Surgical management can be either wide excision with more than 1 cm margins or mastectomy without axillary surgery. Local recurrence has been associated with inadequate excision of the pseudopod. Adjuvant radiotherapy is recommended for positive surgical margin and for local control of borderline and malignant phyllodes tumors. The role of chemotherapy and endocrine therapy has not been fully studied.

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“…A wide local excision (for a small mass) and a "radical mastectomy" for large masses should be followed by radiotherapy if the histological features point towards malignancy. Another indication of radiotherapy is a case of recurrent tumour [5]. Adjuvant radiotherapy in a multicentre study of 46 patients has been found to reduce the risk of local recurrence to zero [5].…”

Section: Discussionmentioning

confidence: 99%

“…Another indication of radiotherapy is a case of recurrent tumour [5]. Adjuvant radiotherapy in a multicentre study of 46 patients has been found to reduce the risk of local recurrence to zero [5].…”

Section: Discussionmentioning

confidence: 99%

Surgical Resection of Phyllodes Tumour: a Radical Approach as a Safeguard Against Local Recurrence

2013

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Phyllodes tumour is a rare benign neoplasm of the breast. It is a mixed tumour of epithelial and mesenchymal origin. The epithelial element is characterized by proliferation of ductolobular units. The fibrous tissue and collagen bundles represent the mesenchymal element. It is also known as "cystosarcoma" phyllodes to characterize some important features, viz. cyst-like or cleft-like spaces within the mass along with a leaf-or frond-like pattern of the stromal element. The tumour is well known for its high potential for local recurrence. Most patients in developing countries present with very large breast tumours with close proximity to the skin and pectoralis major. In these cases, there is a need to perform a three-dimensional en bloc removal of the mass with overlying skin and underlying muscle(s). If a skin flap is raised in the vicinity of the tumour, there is a risk of cutting close to the tumour, increasing risk of local recurrence. Here, we describe a surgical technique that permits a three-dimensional en bloc removal of phyllodes tumour.

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A Prospective, Multi-Institutional Study of Adjuvant Radiotherapy After Resection of Malignant Phyllodes Tumors

Cited by 197 publications

References 38 publications

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

Approaches to phyllodes tumour of the breast: a review article

Surgical Resection of Phyllodes Tumour: a Radical Approach as a Safeguard Against Local Recurrence

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